Although infectious diseases like diarrhoea, respiratory tract infection, malaria & tuberculosis are common in Bangladesh, it is being appreciated only now that the prevalence of chronic non-communicable diseases including diabetes mellitus, hypertension and cardiovascular diseases is rising in South Asian countries. Surveys in Bangladesh have shown the prevalence of diabetes amongst adults to be 8-10% in urban areas and 4-5% in rural areas. Similarly, 10-20% adults in rural areas have elevated blood pressure. The lack of national registry and data regarding ESRD has hampered the recognition of this silent epidemic. The number of patients needing RRT in Bangladesh has varied from 100-200 per million population. Glomerulonephritis (40%) continues to be the commonest cause of ESRD, with diabetes mellitus (24%) and hypertension (13%) being the other leading causes of CKD. Most patients who develop ESRD in Bangladesh have no access to nephrology services. Those who are able to see a neprhologist may not start dialysis or undergo transplantation due to lack of financial resources. Of those who start dialysis, most discontinue treatment after a few months due to financial reasons. The annual cost of maintenance dialysis varies from 4000-6000 US$. For kidney transplantation, patients have to spend 4000-6000 US$ in the first year, and 1000-1200 US$ thereafter for immunosuppressive therapy. For a population of >140 million, only 1000 can undergo maintenance dialysis and 50 receive renal transplant annually. It is clear that the present medial care system has failed to meet the need of vast majority of people of Bangladesh who develop ESRD. It is likely that focusing solely on RRT is likely to fall short of enormous needs for primary care of CKD patients. The number of patients with CKD who are at risk of progression to ESRD is not known. Using Cockroft-Gault formula, a survey from rural population determined the prevalence of CKD to be 17%. Certain Non-Governemntal organizations like The Diabetic Association of Bangladesh with its 52 branches, Foundation for Hypertension, and the Kidney Foundation are taking steps for developing cost effective strategies for the control of CKD epidemic in Bangladesh. |